1. Field of the Invention
The present invention relates to a suture securement apparatus. In more particular, the present invention relates to a suture securement apparatus and adhesive suture securement devices which can be utilized in connection with a threading assembly to provide desired securement of a introducer sheath apparatus and/or closure of a percutaneous catheter insertion site.
2. Relevant Technology
Some of the challenges encountered with a percutaneous catheter insertion relate to the maintaining of the catheter within the catheter insertion site and also the proper maintenance of hemostasis subsequent to removal of the catheter from the catheter insertion site. A variety of different suturing techniques have been utilized in connection with the puncture wound of percutaneous catheter insertion sites and the maintenance of catheters within the percutaneous catheter insertion sites. However, inadvertent slipping or removal of catheters and desired closure of puncture wounds of percutaneous catheter insertion sites subsequent to removal of such catheters has resulted in undesirable patient discomfort and potentially a loss of hemostasis.
One of the techniques often utilized with percutaneous catheter insertion sites is the use of a purse string suture. A purse string suture is formed by inserting a suture, such as a monofilament or braided thread into the patient's skin at a position adjacent the insertion site. The practitioner then forms a circular series of continuous stitches which parallel the edges of the wound in a substantially circular pattern. The configuration of the stitches results in a plurality of segments of suture which alternate between being threaded under a portion of the patient's skin and being positioned over the surface of the patient's skin such that the stitch has between three and four segments or stitches which are positioned above the skin around the edges of the insertion site. A tail of the suture is left both at the initial insertion site of the suture and also at the emergent site of the suture such that the purse string suture appears to have two tails which emerge somewhat close in proximity to one another at a predetermined point around the edges of the insertion site.
The purse string sutures allow a practitioner to close the puncture wound of the insertion site by simply pulling on the two ends of the suture, thus tightening the suture which is then threaded around the perimeter of the insertion site effectively closing the puncture wound of the insertion site and providing the desired hemostasis. In this manner, excessive compression and other techniques which are typically utilized to stop puncture wound bleeding are not needed.
One of the challenges which has been experienced with purse string suture closure methods and the desired maintenance of hemostasis utilizing the purse string suture relates to the knotting or other techniques for maintaining tension on the adjacent ends of the purse string suture. One mechanism which has been utilized employs a knot at one end of one suture which engages the other suture to maintain the desired tension of the overall length of the purse string suture. However, the knot utilized in connection with such techniques can compromise the integrity of the purse string suture. Additionally, the knot can make subsequent loosening and retightening of the purse string suture difficult if not impractical. Additionally, non-doctor practitioners may be unwilling or uncomfortable with removing such sutures at the end of the procedure. As a result, the doctor must see the patient to remove the suture, or the patient may be required to come in for an office visit that may be inconvenient or otherwise unnecessary.
Another technique which has been utilized is to attempt to utilize a secondary securement apparatus to secure the ends of the suture. However, such techniques utilizing existing secondary securement apparatus often result in excessive tension on the purse string suture which can cause puckering or unnatural distortion of the patient's skin adjacent the purse string suture site. As a result, unnecessary discomfort and/or damage to the patient tissue can result. Moreover, existing secondary securement apparatus can compromise the integrity of the suture, giving rise to the potential that the suture will break. If the suture breaks, there is a risk that hemostasis at the insertion site will be lost and/or slipping of the catheter will occur resulting in partial or total removal of the catheter from the insertion site.